Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Prone Position Ventilation in Severe ARDS Due to COVID-19: Comparison Between Prolonged and Intermittent Strategies

George Karlis
* ORCID logo ,
Despina Markantonaki
,
Sotirios Kakavas
ORCID logo ,
Dimitra Bakali
,
Georgia Katsagani
,
Theodora Katsarou
,
Christos Kyritsis
,
Vasiliki Karaouli
,
Paraskevi Athanasiou
,
Mary Daganou
ORCID logo
Version 1 : Received: 10 April 2023 / Approved: 11 April 2023 / Online: 11 April 2023 (03:57:11 CEST)

A peer-reviewed article of this Preprint also exists.

Karlis, G.; Markantonaki, D.; Kakavas, S.; Bakali, D.; Katsagani, G.; Katsarou, T.; Kyritsis, C.; Karaouli, V.; Athanasiou, P.; Daganou, M. Prone Position Ventilation in Severe ARDS due to COVID-19: Comparison between Prolonged and Intermittent Strategies. J. Clin. Med. 2023, 12, 3526. Karlis, G.; Markantonaki, D.; Kakavas, S.; Bakali, D.; Katsagani, G.; Katsarou, T.; Kyritsis, C.; Karaouli, V.; Athanasiou, P.; Daganou, M. Prone Position Ventilation in Severe ARDS due to COVID-19: Comparison between Prolonged and Intermittent Strategies. J. Clin. Med. 2023, 12, 3526.

Abstract

Ventilation in prone position (PP) for 12 to 16 hours per day improves survival in ARDS. However, the optimal duration of the intervention is unknown. We performed a prospective observational study to compare the efficacy and safety of a prolonged PP protocol with conventional prone ventilation in COVID-19-associated ARDS. Prone position was undertaken if P/F <150 with FiO2>0.6 and PEEP>10cmH2O. Oxygenation parameters and respiratory mechanics were recorded before the first PP cycle, at the end of PP cycle and 4 hours after supination. We included 63 consecutive intubated patients with mean age 63.5 years. Of them, 37 (58.7%) underwent prolonged prone position (PPP group) and 26 (41.3%) standard prone position (SPP group). Median cycle duration for SPP group was 20 hrs and for PPP group 46 hrs (p<0.001). No significant differences in oxygenation, respiratory mechanics, number of PP cycles and rate of complications were observed between groups. The 28-day survival was 78.4% in the PPP group versus 65.4% in the SPP group (p=0.253). Extending the duration of PP was as safe and efficacious as conventional PP, but did not confer any survival benefit in a cohort of patients with severe ARDS due to COVID-19.

Keywords

ARDS; Prone position; COVID-19; Mechanical ventilation

Subject

Medicine and Pharmacology, Pulmonary and Respiratory Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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